MEDICARE: DR. DANIEL DE HAAS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7235	MD

General Provider Information

NPI Number	:	1619988458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL DE HAAS DDS

Provider Business Mailing Address
First Line	:	7101 ANNAPOLIS ROAD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2129
Country	:	US
Telephone Number	:	301-577-6333
Fax Number	:	301-459-5747

Provider Business Practice Location Address
First Line	:	7101 ANNAPOLIS ROAD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2129
Country	:	US
Telephone Number	:	301-577-6333
Fax Number	:	301-459-5747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/08/2007

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